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are disabilities. this is targeting people who are what are called dual eligible eligible for both medicare or medical and medicare. what is long-term care integration? what does that phrase mean? it means the integration of primary and acute care services with long-term services and supports as well as institutional care. so we're talking about bringing the medical model together with the social services model, and they will both be provided by managed care health plans to this population, the dual eligibles, those who are eligible for med ical and medicare so an older population as well as a population with disabilities as well as populations who are older so it's a mix. this plan was prepared because california has instituted a coordinated care initiative. in january of 2012 governor jerry brown introduced the coordinated care initiative. its purpose across the state of california is to improve coordinate and coordination of service delivery for consumer satisfaction of the groups i mentioned and at the same time substantial savings so they want to shift where services are provided
, hearing none, item no. 7. >> the clerk: item 7. action item reconciliation of kaiser medicare rate. >> good afternoon, neale kosher. nice to see everyone again. i'm going to walk you through the document labeled kaiser medicare rate final rate for 2014. when we met on june 13th of this year, we stated that the medicare advantage rates for kaiser were preliminary, that we needed to get additional information brought to kaiser. they cooked the final rates and they would let you know at that time. as soon as we knew what they were and then we can talk about how we decide what to do whether they would have to be higher, the rates or lower. we always hope because of the timing and everything comes in better and there is money to be appropriated in some fashion for the cost of the rates. we finalized everything in the system. that is done to be clear on that part. so what happened was kaiser did their magic and got their final numbers and our number we posted at the 14th of june was $346.45. the final number is $344. that saves the city $2.8 million. which is a very good thing. they do
day in the hospital in california for 2011. and what medicare pays and what commercial payers pay and this is adjusted by cost of the living. medicare pays more. for whatever reason, cost per day is higher in san francisco under the medicare program. if you look at commercial payers, they pay much more in san francisco than los angeles. well, one the main reasons is los angeles is a much more competitive market. within 30 miles of usc, there's 70 different hospitals and there's not so much systems so the plans can negotiate to keep prices down. they can pick this hospital and that hospital. they're not forced to take and some markets they are , and that's why prices have gone up. at the bottom you can see this kind of summary measure is in san francisco, commercial plans pay 240 percent of medicare and in los angeles it's close to 200 percent. and that points to the differences in regional competitive structure. can what be done? policies to provide a market. some of these were talked about your earlier speaker. we need to go through and i think we're going to need reg
river side and santa clara so those count ies are now getting up to speed integrating medicare and medical funds for the target populations in those counties to be served through managed care health plans. alameda county is doing an enormous amount of work we're tracking those closely. in 2016 there will be 8 other counties included san francisco we anticipate will be one of those counties in 2016 so what we're doing now is to take this time to get ready to learn what's happening in the other 8 county ies so that we can do the best possible job for all of the people who are going to be transitioning to this demonstration project in san francisco. san francisco is what is known as a two plan model. we have the san francisco health plan which some of you may have heard of which is the public option and we have anthem blue cross which is the commercial plan and we have a third option the pace program provided through on lock so those 3 options will be available for the target population that i mentioned older adults who are dually eligible and they will enroll either by choice
shows that hospitals charge medicare different amounts, even ten to 20 times what medicare reimburses for the same procedure. this initial analysis also raises questions about how hospitals determine prices and why they vary. the first look at this data reveals there's wide variations around hospitals and here in san francisco. as now also a member of the health service board and as one of the supervisors involved in the snc negotiations, i realized how crucial health care is important. the second item is a resolution to pass legislation to establish full transparency. consumers and employees are asked to pay more and more in premiums and costs. price transparency in the health care market is essential to bring price down. recently the lack of transparency in health karin creases for public employees jeopardizes health care for workers. it's hard to improve rates and we as a board owes to our resident to have more into health care cost so we begin to move toward competitive pricing that benefits all of our resident. we have a line up of speaker for today's hearing and i want to
under way dually eligible people with medical and medicare. and also, this partial medical under california undertook as part of the 1115 waiver called the programs and passed here in san francisco we did learn that they were not opt mal, and we think that 60 percent of the folks will be medical eligible and the rest minus obviously the folks who will remain uneligible will be eligible for the qualified health plans through coverage california. and the transition is less mandatory and is strongly encouraged and something that we are working towards. and again, for the less beneficiaries and in the past we will be moving into the medical expansion and some other counties that we see them moving into coverage california as well. and then there is the piece that programs that was a temporary program that is ending so she will also be facing transitions and the mission of the task force that formed nearly a year ago to develop a set of recommendations. and our goal and preparing the community based hiv providers for the changes that are coming to their funding and also preparing the
. medicare fails to cover $3.8 billion in the actual cost in hospital of a providing care to the elderly. >> can i ask a question about that. i don't dispute that, however, as we're talking about transparency, it affects -- maybe this is not the case, but everyone the same, under funding the mandate affects hospital a or hospital b depending on their patient mix, it's something that plagues all of us, how's that. >> correct. >> i appreciate the perspective from the health care provider and insurance provider, but if we're talking about -- i take it from the consumer perspective. again, if i'm being the case of -- if i'm being asked to pay 20 percent of my x-ray, it seems logical that as those shifts -- it's not just my premiums that i'm worried about, but it's premiums plus out of pocket. i want to know, hey, you know what and as professor king and i hope she's doing ok, at the time i choose my plan and at the time of procedure, to know what health plan and what provider is going to provide -- i want to know if one is charging $1500 bucks verses 100. that's viable to know. to me that
and according to an article in business, dialysis, facilities participating in medicare, as of october 2008 which we certainly were, may continue to use non-sprinklered buildings if the buildings were constructed before january first, 2008 and state law permits. i am not a fire experts, so i don't know if sprinklers are needed or not. but, i want to point out, that if sprinklers are needed the last page of the survey which i left at home but i will forward to you says that there be a recommendation for wave and provision if the specific provision of the code would result in unreasonable hardship on fat celebrity. and even if a waiver was impossible and the sprinklers were required and the cost of those sprinklers would be less than ten years of shuttle service. >> thank you very much. >> thank you. >> next speaker, please? >> >> i would like to begin by thanking you particularly for holding this hearing and giving us the opportunity to speak and we appreciate it. >> my name is crystal and i am lucky enough to be the lead organizer for ask me 3299 in san francisco and behind me are lucky peo
for medicare and medicaid services introduced new fire life safety codes, those codes, for the buildings that currently houses the dialysis center does not meet both the fire and life safety codes and so we have been and continue to live on borrowed time and at any point, when cms comes back to do the regulatory investigation, we will not pass, we don't meet the requirements for the physical, constraints of a building. and a brief overview, in terms of the patients who actually receive services at the sfgh location, and this gives you a zip code and break down and district break down. and also it shows miles to sfgh and smiles to laguna honda. and so we recognize, transportation, is an issue, and as part of this process, we are committed to doing anything that we can to bring resources to help to mitigate any transportation barriers that might be presented as a result from the move from san francisco general to laguna. >> can i ask you about this slide, what does it mean when it says ward 17 and com sites? what is the difference between the two? >> the award 17 is the building, the build
of having the financial resources to access them. it is not covered under medical or medicare to some degree it is if the providers want to work with them but it's still not enough to be able to allow or grant enough access so that's an issue i think can be explored more as far as the vendors their availability to have it covered through medical and also working to see about trying to diversify to make it more accessible. second in the picture in the middle i have a picture of one of our co-workers peter mendoza who's using his electric power chair but more importantly he has a setup of 2 smart tablets being held up in front of him by a coil type of clamp. hey peter, thank you. [laughter]. >> for those who are here peter is approaching and he's showing off his setup system. by having these thin but sturdy clamps he's able to access his smart devices really important for getting around the city when at work for checking e-mails basically being able to increase his capacity to work and access the community. thank you peter. lastly on the right i have a picture of a hurricane -- spe
for the future of the active and early retiree pool. one is move the pool with medicare retirees. the second would be to close the active city plan to all employees other than those outside the kaiser and blue shield service areas such as the heche but very small. third we ask and investigate the policies to make the changes to the active plan to draw more people into it to make the plan affordable again. howevercious that does have a down side that it might cause increase rate in population which is a higher volume than the uhc plan. what i want to say these are the consideration we have and they can all concur as individuals or in groups of two or three of the options if you want. so with that, i would entertain any questions that you may have. >> mr. scott? >> i wanted to go back to your slide 26. you identified for early retirees with diabetes is kind of a therapy that is impacting cost. are you seeing a similar trend around the things around cardiovascular disease related issues? >> when i looked at the top drugs i did not see a repeat, you have the stat ins but because of diabetes you
conversion from the pharmacy medicare benefits. there was $1.5 million in the flex plan for 2013. $3.1 million net decrease in the blue shield's fully in insured's plan from july through december by the 2 percent premium pledge and $1.6 million net increase in other benefits. so, that nets you -- us out to the $77.3 million. we have a net point 6 million. that is a continue -- continue contingency in reserves. $9.1 million in initiatives to reduce cost and $3.8 million in early retirement in insurance program that we have to spend by the end of 14. $3.4 million in premium credits for those units that accepted the 90-83 in #5shgs 2015. what are the next steps? the controllers will public the annual financial report which you may have heard kafrd. sometimes around the beginning of the month and that is contain a high level of dbi's funding and this is a separate audit we have to do and it is available on our website we posted it and we also have copies for anybody that is interested. and then as i mentioned, the reserve levels will be evaluated in february 2014. i am open to any que
Search Results 0 to 42 of about 43 (some duplicates have been removed)